Anaphylatic Reaction and IVPB

[Alie]

I am confused. If someone starts having an anaphlyatic reaction to an IVPB of like PCN what would you do 1st. Stop Pump, disconnect tubing, and flush the lowest port. But what do you do about med that is in tubing above lowest port.

This was brought up by a teacher the other day and this is what was said. To stop it at the lowest port and flush (my question is how do you stop it at the lowest port esp if it connected to the hightest port, just by pinching or clamping??). I even went back and listened to my tape and it was not made clear. I didn't know if you would try to aspirate fluid out, but this would be time consuming. I guess you could while waiting for Dr.'s orders or for him to get there.

[meownsmile, BSN, RN]

Stop the pump, and completely change out the primary tubing. Some drugs have residuals that cling to the inner lumen of the tubing so just flushing may not get it all.

I would completely change tubings to prevent any further reaction. Hopefully you would have it the IVPB connected to the pump at the chamber, so you have everything below the pump that has medication in it. Disconnect at the lock port,(hopefully they have one) at the site, flush the lock port, respike the fluids with new tubing, restart fluids and call for orders.

[passing thru]

First, I'd disconnect the ivpb from the tubing. Hopefully it was "plugged in" above the pumb. Then, I'd hightail it to the nearest 10 cc syringe. I'd stick the 10 cc syringe in at the lowest port, take the tubing out of the pump, open it up , and withdraw from the lowest port...withdraw slowly...watch the drip chamber, the fluid should be running down the drip chamber.

After you have filled the 10 cc syringe, dispose of it and reconnect the tubing to the pump and turn it on the keep your iv patent.

If the pt is going to code, you want to preserve your iv site.

I'd hang a bag of saline at this time, I'd replace whatever was hanging with normal saline.

You can do these things without waiting for the doctor.

The first flush that you mentioned is a waste of time. I'd go immediately and get the 10 cc syringe and an 18 gg needle if it is handy.

The priority here is to be QUICK ! You want to maintain your iv site and keep it open with the smallest amount of any more pcn going in.

Turning it off and disconnecting the tubing at the needle hub is also an option. Again, you have to be quick to save your iv access.

Of course it helps if you have a pal starting iv access in the opposite arm while you are trying to salvage this one without infusing any more pcn.